What is bivalirudin?
Direct thrombin inhibitors are another type of anticoagulant or blood thinner. Bivalirudin (Angiomax) is the most common. These medications not only reduce the likelihood of blood clots forming, but they also prevent clots that have already formed from getting bigger.
What is it used for?
Direct thrombin inhibitors have been approved to treat heparin-induced- thrombocytopenia, a type of allergic reaction triggered by regular heparin that results in a dangerously low level of platelets (blood cells involved in clotting, also called thrombocytes).1 They are still being investigated as potential replacements for regular heparin.
When all the studies on direct thrombin inhibitors were pooled, bivalirudin was superior to regular heparin at reducing the risk of having a heart attack.4 This pooled analysis included people with unstable angina, heart attack, and those undergoing angioplasty or stenting. The benefits were greatest for people who underwent angioplasty and stenting. In these patients, bivalirudin was less likely to cause bleeding problems than regular heparin. In contrast, bivalirudin actually increased the risk of bleeding problems in people with unstable angina or heart attack. Most of the research studies included in this analysis were done before the routine use of super aspirins ( glycoprotein IIb/IIIa inhibitors) so it remains to be seen how bivalirudin would perform in combination with super aspirins. These pooled results did not show any benefit for direct thrombin inhibitors, other than bivalirudin compared with regular heparin.5
Direct thrombin inhibitors are not generally given to heart attack patients. Studies show that combining bivalirudin with clot busters reduces the risk of subsequent heart attack compared with regular heparin. However, this benefit is outweighed by a significant increase in bleeding problems.6 Direct antithrombins may be combined with the clot buster streptokinase in heart attack patients who are allergic to regular heparin.7
As with LMWH, more research needs to be done before physicians are likely to switch from regular heparin to bivalirudin.
Direct Thrombin Inhibitor Quick Reference Table
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DIRECT THROMBIN INHIBITORS
(Check with manufacturer for specific information) |
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Bivalirudin |
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Lepirudin |
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Brand: |
Angiomax |
Argatroban |
Refludan |
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Given: |
Injected into an IV line |
Injected into an IV line |
Injected into an IV line |
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What is it |
To treat people with unstable angina undergoing angioplasty/stenting |
To treat people with heparin-induced thrombocytopenia (HIT) |
To treat people with (HIT) |
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You should |
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Pregnancy/ |
It is not known whether these medications are safe during pregnancy or nursing. |
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